Fetal pain

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Fetal pain is a subject of intense political and academic debate. The ability of a fetus to feel pain and suffering is often part of the abortion controversy.[1] [2] Determining the stage of pregnancy at which a fetus is able to feel pain or suffering could have a significant effect on the abortion debate as well as abortion laws and practices. For example, legislation has been proposed requiring abortion providers to tell a woman that the fetus may feel pain during the abortion procedure, and requiring her to accept or decline anesthesia for the fetus.[3]

A lack of fetal pain does not necessarily "resolve the question of whether abortion is morally acceptable or should be legal".[4] Still unresolved would be whether "the obligation not to harm other human subjects extends considerably beyond that of not causing pain."[5]

Most scientists believe that a fetus is able to feel pain sometime during the pregnancy, often beginning less than 24 weeks after conception, although the question of exactly when pain might be possible is disputed.[6] Some academics argue that it appears as early as seven weeks after conception. Others claim that pain cannot be felt until the third trimester of pregnancy or until after birth.[7]

There may be an "emerging consensus among developmental neurobiologists that the establishment of thalamocortical connections" (at about 26 weeks) is a critical event with regard to fetal perception of pain.[8] Nevertheless, because pain can involve sensory, emotional and cognitive factors, it is "impossible to know" when painful experiences may become possible, even if it is known when thalamocortical connections are established.[8] According to Arthur Caplan, "there is no consensus among the medical and scientific experts about precisely when a fetus becomes pain-capable. Some put the point at 28 weeks. Others say 26 or 24 and still others younger still."[9]

Multiple nerve systems are involved in the sensation of pain and nociception. When the brain and nervous system are fully developed, the sensation is triggered by nociceptors reacting to some stimulus. The resulting signal travels via the peripheral nervous system to nociceptors associated with the spinal column. It then travels up the spinal column to the thalamus, and onward to the cerebral cortex, where it is finally interpreted as a painful sensation. Pain "may exist even in the absence of physical stimuli," and conversely "nociception without pain" exists as well.[10] Some scientists believe "the cortex is not required for conscious sensory perception."[11]

Early in development, from about 12-18 weeks gestation, there is a complete link from the periphery to the thalamus in the brain, and the fetus shows clear evidence of defensive reactions against tissue damage including hormonal and hemodynamic responses. After about 26 weeks gestation there is a complete link from the thalamus to the cortex of the brain. Cortical responses in premature babies of about 25 weeks gestation have been recorded during the usual heel lance procedure performed shortly after birth (for blood sampling). In summary, there is good evidence that from about 26 weeks gestation the fetal brain can be considered a functional unit capable of processing noxious sensory input, and pain before that point may also be possible.

[edit] Medical opinions

In 1980, Stanislav Reinis and Jerome Goldman wrote that, "The first detectable brain activity in response to noxious stimuli occurs in the thalamus between the ninth and tenth weeks."[12]

In 1984, anesthesiologist Vincent J. Collins wrote: "because the requisite neurological structures are present at that time and because they are functioning, as evidenced by the aversive response of the human fetus, it may be concluded with reasonable medical certainty that the fetus can sense pain at least by 13 ½ weeks."[13] Dr. Collins was one of several scientists who wrote an open letter to President Reagan, asserting that, "The ability to feel pain and respond to it is clearly not a phenomenon that develops de novo at birth....by the close of the first trimester the fetus is a sentient, moving being."[14]

A 1988 study observed changes in heart rates and hormonal levels of newborn infants after circumcision, blood tests, and surgery — effects which were alleviated with the administration of anesthesia.[15]

In 1995, Dr. Robert J. White, director of the Division of Neurosurgery and Brain Research Laboratory at Case Western Reserve School of Medicine and a member of the Vatican's Pontifical Academy of Sciences, gave testimony before the House Constitution Subcommittee of the Congress of the United States. He stated that, at 20 weeks' gestation, the fetus "is fully capable of experiencing pain...Without question, all of this is a dreadfully painful experience for any infant subjected to such a surgical procedure."[16]

In 1996, developmental physiologist Peter McCullagh wrote: "At what stage of human prenatal development are those anatomical structures subserving the appreciation of pain present and functional? The balance of evidence at the present time indicates that these structures are present and functional before the tenth week of intrauterine life."[5]

In 1997, Dr. Paul Ranalli, a neurologist at the University of Toronto, cited several observations to support the belief that a fetus can experience pain, including observing a fetus "withdraw from painful stimulation", and the fact that stress hormones detected in pain-stricken adults have also been found in the blood samples of aborted fetuses.[17] Dr. Ranalli is a member on the Advisory Board of the deVeber Institute for Bioethics and Social Research, a pro-life organization.[18] The group Canadian Physicians for Life cites Ranalli for the proposition that, "enough development has occurred by 12-14 weeks that some pain perception is likely."[19]

Also in 1997, a "Working Party" appointed by the Royal College of Obstetrics and Gynaecology in the United Kingdom stated that "very early in pregnancy fetuses will react to stimuli, but that reaction does not in itself provide any evidence that the fetus experiences those stimuli."[20] The Working Party further stated that, "Little sensory input" reaches the brain of the developing foetus before 26 weeks, and "therefore reactions to noxious stimuli cannot be interpreted as feeling or perceiving pain."[21]

In 1999, it was noted in the British Journal of Obstetrics and Gynaecology that, "The first neurones to link the cortex with the rest of the brain are monoamine pathways, and reach the cortex from about 16 weeks of gestation. Their activation could be associated with unpleasant conscious experience, even if not pain."[22]

In 2001, a working group of the Medical Research Council (UK) in the United Kingdom suggested that doctors should consider the use of analgesia and sedation for fetuses over 24 weeks of age undergoing surgery.[23] Dr. Eve Johnstone, the chair of that working group, told The Daily Telegraph that a fetus was aware of pain by 24 weeks, maybe as early as 20 weeks,[24] because "[c]onnections from the thalamus to the cortex begin to form at about 20 weeks gestation."[25] Dr. Susan Dudley of the National Abortion Federation in the U.S. responded: "The obvious and most important thing to say is most abortions take place before 20 weeks."[26]

In 2005, Mellor and colleagues reviewed several lines of evidence that suggested a fetus does not awake during it's time in the womb. If the fetus is asleep throughout gestation then the possibility of fetal pain is greatly minimised. [27]

Later in 2005, a meta-analysis of existing experiments published in the Journal of the American Medical Association (JAMA) concluded that the limited available evidence indicates fetal perception of pain is unlikely before the third trimester, and that electroencephalography suggests the capacity for functional pain perception in premature infants probably does not exist before 29 or 30 weeks; this study asserted that withdrawal reflexes and changes in heart rates and hormone levels in response to invasive procedures are reflexes that do not indicate fetal pain.[10] This meta-study was criticised by pro-life groups who were skeptical because of the prior involvement of several authors of the report. One directs an abortion clinic at San Francisco Hospital, while the lead author undertook legal work with NARAL Pro-Choice America for six months.[28]

Also in 2005, the meta-study published in JAMA was criticized by K. J. S. Anand:

"The conclusions of Lee and colleagues regarding fetal pain are flawed, because they ignore a large body of research related to pain processing in the brain, present a faulty scientific rationale and use inconsistent methodology for their systematic review. Based on the available scientific evidence, we cannot dismiss the high likelihood of fetal pain perception before the third trimester of human gestation….Fetal development of the thalamus occurs much earlier than the sensory cortex, providing the substrate and mechanisms for conscious pain perception during the second trimester, but not in the first trimester...." [11]

In November of 2005, Dr. Jean Wright testified to Congress that data "shows 16 weeks and even earlier, many of these infants feel pain and have negative outcomes from it."[29]

In 2006, a clinical review published in the British Medical Journal concluded that pain is dependent upon cognitive and emotional developments that occur after birth:

"Theories of development assume that the early human mind begins with minimal content and gradually evolves into the rich experience of older children and adults. Although the view of a neonate as a blank slate, or tabula rasa, is generally rejected, it is broadly accepted that psychological processes have content concerning people, objects, and symbols, which lay in the first instance outside the brain. If pain also depends on content derived from outside the brain, then fetal pain cannot be possible, regardless of neural development." [4]

Also in 2006, a study in the Journal of Neuroscience stated: "We conclude that noxious information is transmitted to the preterm infant cortex from 25 weeks, highlighting the potential for both higher-level pain processing and pain-induced plasticity in the human brain from a very early age." [30]

[edit] References

  1. ^ White, R. Frank. "Are We Overlooking Fetal Pain and Suffering During Abortion?", American Society of Anesthesiologists Newsletter (October 2001). Retrieved 2007-03-10.
  2. ^ David, Barry & and Goldberg, Barth. "Recovering Damages for Fetal Pain and Suffering", Illinois Bar Journal (December 2002). Retrieved 2007-03-10.
  3. ^ Weisman, Jonathan. "House to Consider Abortion Anesthesia Bill", Washington Post 2006-12-05. Retrieved 2007-02-06.
  4. ^ a b Derbyshire, S.W.G. (2006). Can fetuses feel pain?. British Medical Journal, 332 (7546), 909-12. Retrieved 2006-12-23. Derbyshire has served as an unpaid consultant to Planned Parenthood of Virginia and Planned Parenthood of Wisconsin, as well as the U.K.-based Pro-Choice Forum. See "Fetus Cannot Feel Pain, Expert Says", Forbes (2006-04-14). Retrieved 2007-03-10. A news report about the Derbyshire article can be found here: "Foetuses 'cannot experience pain'", BBC News (2006-04-13). Retrieved 2007-03-14.
  5. ^ a b McCullagh Peter. "Fetal sentience. London: All-Party Parliamentary Pro-Life Group (1996). Dr. McCullagh is a Senior fellow in developmental physiology at the John Curtin School of Medical Research, Australian National University. This report was reprinted in the Catholic Medical Quarterly, XLV11 no 2, November 1996, p6. Retrieved 2007-03-10.
  6. ^ Derbyshire, David, Foetuses 'may be conscious long before abortion limit', Telegraph (UK) 2003-09-03: "a Daily Telegraph straw poll found many neurologists were concerned that foetuses could feel pain in the womb before 24 weeks after conception."
  7. ^ Robinson, B.A. (2006). Can a fetus feel pain?. Ontario Consultants for Religious Tolerance. Retrieved December 14, 2005.
  8. ^ a b Johnson, Martin and Everitt, Barry. Essential reproduction (Blackwell 2000): "The multidimensionality of pain perception, involving sensory, emotional, and cognitive factors may in itself be the basis of conscious, painful experience, but it will remain difficult to attribute this to a fetus at any particular developmental age." Retrieved 2007-02-21.
  9. ^ Caplan, Arthur. Testimony to U.S. Congress, Subcommittee on the Constitution, Civil Rights, and Civil Liberties. "Oversight Hearing on Pain of the Unborn." (2005-11-01). Retrieved 2007-03-10.
  10. ^ a b Lee, Susan J., Ralston, Henry J. Peter, Drey, Eleanor A., Partridge, John Colin, & Rosen, Mark A. (2005). Fetal Pain: A Systematic Multidisciplinary Review of the Evidence. Journal of the American Medical Association, 294 (8), 947-954. Retrieved 2007-02-26. "Evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester....electroecephalography suggests the capacity for functional pain perception in preterm neonates does not exist before 29 or 30 weeks." A news report about this JAMA study can be found here: "Foetuses 'no pain up to 29 weeks'," BBC News (2005-08-24). Retrieved 2007-03-14.
  11. ^ a b Anand, K. A Scientific Appraisal of Fetal Pain and Conscious Sensory Perception", written testimony to Congress (2005). Retrieved 2007-03-10.
  12. ^ Reinis, Stanislav and Goldman, Jerome. The Development of the Brain (Thomas 1980).
  13. ^ Collins, Vincent et al. "Fetal Pain and Abortion: the Medical Evidence", Studies in Law and Medicine, No 18 (1984).
  14. ^ Schmidt, Richard et. al., "Open Letter to President Reagan" (1984-01-31). Retrieved 2007-03-14.
  15. ^ Anand, K., Phil, D., & Hickey, P.R. (1987). Pain and its effects on the human neonate and fetus. New England Journal of Medicine, 316 (21), 1321-9. Retrieved 2006-01-11 from The Circumcision Reference Library.
  16. ^ White, Robert. Testimony to U.S. House Judiciary Committee, Subcommittee on the Constitution (1995-06-15). Quoted in this congressional report. Retrieved 2007-03-10.
  17. ^ Ranalli, Paul. "Pain, Fetal Development, and Partial-birth abortion" (1997-06-27).
  18. ^ The deVeber Institute for Bioethics and Social Research. (2004). Perspectives 2004. Retrieved 2006-12-23.
  19. ^ Canadian Physicians for Life. Retrieved 2007-03-10.
  20. ^ Fetal Awareness Report of a Working Party RCOG Press. October 1997.
  21. ^ 'Abortion causes foetal pain' BBC.co.uk. 29 August, 2000. Accessed 2007-03-09. A British government report said in 2007 (shortly before the RCOG report) that signals from the thalamus begin to reach the cortex between "22-34 weeks" after conception. See Parliamentary Office of Science and Technology,Fetal Awareness (February 1997). Retrieved 2007-03-15.
  22. ^ Glover, Vivette and Fisk, Nicholas. "Fetal Pain: Implications for Research and Practice", British Journal of Obstetrics and Gynaecology (1999) Retrieved 2007-03-10. Also see "Abortion causes foetal pain", BBC News, (2000-08-29): "Professor Vivette Glover from Queen Charlotte's and Chelsea Hospital in London, says she believes that foetuses over 17 weeks old may feel pain." Retrieved 2007-03-10.
  23. ^ Medical Research Council, Fetal Pain - Research Review (2001-08-24). Retrieved 2007-03-10.
  24. ^ Highfield, Roger. "Very premature babies may need pain relieving drugs," The Telegraph (2001-08-27). Retrieved 2007-03-10.
  25. ^ Medical Research Council, Fetal Pain - Research Review (2001-08-24). Retrieved 2007-03-10.
  26. ^ Beaucar, Kelley. Fetal Study Adds Fuel to Late-Term Abortion Debate, Fox News (2001-08-31). Retrieved 2007-03-10.
  27. ^ Mellor D.J., Diesch T.J., Gunn A.J., & Bennet L. (2005). The importance of ‘awareness’ for understanding fetal pain. Brain Research Reviews, 49(3), 455-71. Retrieved December 23, 2006.
  28. ^ Bazar, Emily. 2 authors of fetal-pain paper accused of bias, USA Today (2005-08-24). Retrieved 2007-03-10.
  29. ^ Wright, Jean. Testimony to U.S. Congress, Subcommittee on the Constitution, Civil Rights, and Civil Liberties. "Oversight Hearing on Pain of the Unborn." (2005-11-01). Dr. Wright is Professor and Chair of Pediatrics, Mercer School of Medicine. Retrieved 2007-03-10.
  30. ^ Slater, Rebecca et al. "Cortical Pain Responses in Human Infants", Journal of Neuroscience, (2006-04-05). Retrieved 2007-03-10.

[edit] External links

  • Pro-life site presenting case for fetal pain from second month of pregnancy: HTML version.
  • 109th Congress, U.S.A. "Unborn Child Pain Awareness Act of 2005." 1st Session, S.51. (January, 2005). PDF version, HTML version
  • National Right to Life Committee's webpage of testimonies regarding fetal pain. HTML version
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